THIS FILE INCLUDES FILLABLE FORM FIELDS. YOU CAN PRINT THE COMPLETED FORM & SAVE IT TO YOUR DEVICE OR PRINT OFF & FILL OUT.
CANDISC
application 2015
August 1st-8th, 2015 * Tour of Champions
Bike Tour Rate:
Number of Riders x $220.00
#
=$
(Includes 1 free CANDISC shirt per rider)
#
Number of Families x $450.00
=$
Husband, Wife, and children 18 & under
(Includes 1 free CANDISC shirt per rider)
#
Late Fee Added after July 15th x $40.00
=$
Day Tour Rate:
Number of Days x $55.00
#
=$
(For Riders who plan to ride only certain days, not the
entire week. CANDISC shirt not included.)
Check the days you will be riding:
☐ Sunday, Aug. 2
☐ Monday, Aug. 3
☐ Wednesday, Aug. 5 ☐ Thursday, Aug. 6
☐ Saturday, Aug. 8
☐ Tuesday, Aug. 4
☐ Friday, Aug. 7
Support Vehicle Rate:
Number of Support Vehicles x $35.00
#
=$
(Any vehicle accompanying a rider must register. Driver &
Non-Rider passengers)
Meal Plan Rate:
Number of Full Meal Plans x $140.00
#
=$
(Includes 7 Breakfast Meals & 7 Supper Meals)
#
Number of Supper Only Meal Plans x $95.00
=$
(Includes 7 Supper Meals, NO Breakfast Meals)
#
Number of Breakfast Only Meal Plans x $65.00
=$
(Includes 7 Breakfast Meals, NO Supper Meals)
Additional Purchases:
Number of Additional CANDISC Shirts x $16.00
#
Select T-Shirt Size(s):
Sm
Med
Lg
XL
=$
XXL
TOTAL FEES =$
THIS FILE INCLUDES FILLABLE FORM FIELDS. YOU CAN PRINT THE COMPLETED FORM & SAVE IT TO YOUR DEVICE OR PRINT OFF & FILL OUT.
Please fill out all information below:
Name:
Age:
Address:
City/ State/Zip:
Home Phone: ( )
Cell Phone: ( )
Email Address:
☐Rider
☐Non-Rider/ Support Vehicle
Enclosed Waiver: ☐
Shirt Size (If Included):☐Sm ☐Med ☐Lg ☐XL ☐XXL
List All Additional Riders and Non-Riders:
Name:
Age:
Address:
City/ State/Zip:
Phone: ( )
Email Address:
☐Rider
☐Non-Rider/ Support Vehicle
Enclosed Waiver: ☐
Shirt Size (If Included):☐Sm ☐Med ☐Lg ☐XL ☐XXL
Name:
Age:
Address:
City/ State/Zip:
Phone: ( )
Email Address:
☐Rider
☐Non-Rider/ Support Vehicle
Enclosed Waiver: ☐
Shirt Size (If Included):☐Sm ☐Med ☐Lg ☐XL ☐XXL
Name:
Age:
Address:
City/ State/Zip:
Phone: ( )
Email Address:
☐Rider
☐Non-Rider/ Support Vehicle
Enclosed Waiver: ☐
Shirt Size (If Included):☐Sm ☐Med ☐Lg ☐XL ☐XXL
Name:
Age:
Address:
City/ State/Zip:
Phone: ( )
Email Address:
☐Rider
☐Non-Rider/ Support Vehicle
Enclosed Waiver: ☐
Shirt Size (If Included):☐Sm ☐Med ☐Lg ☐XL ☐XXL
THIS FILE INCLUDES FILLABLE FORM FIELDS. YOU CAN PRINT THE COMPLETED FORM & SAVE IT TO YOUR DEVICE OR PRINT OFF & FILL OUT.
CANDISC agreement and Waiver/Release of liability
All applicants must read and sign
I, the undersigned, know that CANDISC is a potentially hazardous event and I attend it out of my own free will and
choice. In choosing to attend CANDISC and any related event, I fully accept and assume all risks, whether before,
during or after CANDISC and its related events. These include, without limitation, risk of physical injury, mental
injury, emotional distress, trauma, death, contact with other participants, equipment failure, inadequate safety
equipment, the effects of weather including extreme temperatures or conditions, traffic, contact with motor
vehicles of all types and descriptions, collision with other riders or fixed objects, the conditions of the road,
camping, and participating in events along the route. All risks are known and appreciated by me. I waive any and
all specific notice of the existence of the risks. I shall assume and pay my medical and emergency expenses in the
event of injury, illness, or other incapacity regardless of whether I authorized such expenses.
I realize that CANDISC requires physical conditioning and I represent that I am in sound medical condition capable
of participating in the ride without risk to myself or others. I have no medical impediment which would endanger
myself or others. I understand and agree that a situation may arise during CANDISC which may be beyond the
control of the sponsors, promoters or organizers. I will be solely responsible for the condition and adequacy of my
bicycle, safety gear and riding equipment. I will ride safely within the limits of my own ability, my equipment and
the riding condition and in a manner so as not to endanger either myself or others.
Knowing these facts and in consideration of my entry acceptance, admission to and/or participation in CANDISC
and its related events, I for myself and anyone acting on my behalf release waive, discharge, covenant not to sue
and agree to hold CANDISC; CANDISC sponsors and participating clubs, communities and organizations; CANDISC
officials, emergency and support personnel, volunteers and their representatives; and the officers, directors,
employees, representatives, agents, insurers, insurance brokers, and successors of all the above, harmless from
any and all claims, demands and actions of any and every kind I have, may have or may hereafter accrue against
the released parties directly or indirectly arising out of or relating in any respect to my attending or participating in
CANDISC and its related events.
I agree to abide by all CANDISC rules and regulations. I understand that my name, address, photograph, voice
and/or likeness may be used in promotional or advertising materials of/or by CANDISC, and its licensees. I consent
to such uses and waive any rights of privacy or publicity I may have in connection with those uses. I further agree
to indemnify and hold the parties released above harmless from any and all losses, damages, claims and expenses,
including attorney’s fees, arising from or relating in any respect to my participation in CANDISC or its related
events or my breach of this agreement. If I am a minor, my parent or guardian also is signing on my behalf and
agreement, waiver and release.
I have read this agreement, waiver and release.
Signature: _________________________________________________________Date Signed: __________
Typewritten or Printed Name:
Address:
Phone #:
Age:
Parent or Guardian Signature, if under 18: _______________________________________________________
Sign & return the waiver/ release with your CANDISC Registration Form and Fee along with a
stamped self-addressed business sized envelope to: CANDISC, PO Box 515, Garrison, ND 58540.